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Robin A. Hanks, Ph.D., will use three new National Institute on Disability and Rehabilitation Research grants totaling $2.4 million to develop a more reliable measuring standard of fatigue among people with traumatic brain injury (TBI) and to improve the lives and health of such patients.

“These grants are important not only to further the science regarding outcomes after traumatic brain injury, but also because all of the research projects focus on improving recovery after brain injury, whether it be improved neural recovery, better diagnostic prediction of outcome with neuroimaging or better understanding and diagnosis of fatigue, but also the factors that help persons with brain injury be resilient and strong in their recovery and return to the community,” said Dr. Hanks, chief of Rehabilitation Psychology and Neuropsychology for the Rehabilitation Institute of Michigan and associate professor of Physical Medicine and Rehabilitation for the Wayne State University School of Medicine.

The first grant, for $181,077, will develop a new measure of subjective fatigue among TBI patients. Fatigue is one of the most commonly reported symptoms by such patients, and may be a source for other issues attributed to TBI. However, current standards – there are as many as 30 -- complicate the development of fatigue estimates, the documentation of the history of development of post-injury fatigue, and the design and evaluation of treatment, Dr. Hanks explained.

“This gap in knowledge is the lack of evidence supporting a specific fatigue scale, of the over 30 that have been used for clinical and/or research purposes, which is psychometrically sound, efficient and useful in individuals with TBI to assess treatment interventions and the natural history of fatigue following TBI,” she said.

Dr. Hanks’ research is designed to address this gap. She will evaluate the consistency of a variety of factors to identify a sound measure of fatigue. Santa Clara Valley Medical Center has partnered with the Rehabilitation Institute of Michigan to develop a new fatigue scale, which will lead to improved studies and treatment plans for those with TBI.

A second grant of $593,000 will be used to investigate the relationships among strengths of character, structurally-imaged estimates of white matter damage in frontal brain regions, psychological resiliency and outcomes including satisfaction with life and community integration among TBI patients.

Eighty participants will undergo magnetic resonance imaging, and cognitive and psychosocial evaluation at six months to two years post-injury. Dr. Hanks expects to find that white matter damage in the ventromedial area of the brain “will show inverse associations” with self-reported resiliency. She anticipates that self-reported strengths of character (bravery, kindness, humor and spirituality) will show stronger positive associations with life satisfaction and community integration than other self-reported strengths of character, and that these relations will also hold true for resiliency among people with TBI.

A $1.7 million grant for the Southeastern Michigan Traumatic Brain Injury System will focus on two studies to enhance the health and function of TBI patients. In these projects, Dr. Hanks proposes to evaluate the predictive validity of three new magnetic resonance imaging techniques with respect to functional independence, level of disability and neurobehavioral outcomes one and two years after the initial injury. She also will examine the safety and efficacy of an antibiotic medication thought to be effective in neuroplasticity in the acute stages of recovery from TBI.